Treatment and outcome of patients with intracystic papillary carcinoma of the breast

BACKGROUND: Intracystic papillary carcinoma (IPC) of the breast is a rare form of noninvasive breast cancer. An appreciation of associated pathology with IPC may be critical in surgical decision-making. METHODS: The medical records of all patients with IPC treated between 1985 and 2001 were retrospectively reviewed. Three patient groups were identified according to the pathologic features of the primary tumor: IPC alone, IPC with associated ductal carcinoma in situ (DCIS), and IPC with associated invasion with or without DCIS. Types of treatment and outcomes were compared between groups. RESULTS: Forty patients were treated for IPC during the study period. Fourteen had pure IPC, 13 had IPC with DCIS, and 13 had IPC with invasion. The incidence of recurrence and the likelihood of dying of IPC did not differ between the three groups regardless of the type of surgery (mastectomy or segmental mastectomy) performed and whether radiation therapy was administered. The disease-specific survival rate was 100%. CONCLUSIONS: When IPC is identified, it is frequently associated with DCIS and or invasion. Standard therapy should be based on associated pathology. The role of radiation therapy in pure IPC remains to be determined.     

Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy

Background Our aim was to identify predictors of locoregional recurrence (LRR) in patients with early-stage breast cancer treated with breast-conserving therapy (BCT) and long-term follow-up. Methods From 1970 to 1994, 1153 patients with stage I to II breast cancer underwent BCT and radiotherapy at our institution. Patients with prior breast cancer or other primary malignancies were excluded. Clinical and pathologic characteristics evaluated were age, race, tumor size, stage, pathologic tumor margins, axillary nodal involvement, estrogen and progesterone receptor status, Black's nuclear grade, type of surgery, and use of adjuvant therapy. Results Of 1083 patients, 54% presented with stage I disease and 46% with stage II disease. Median age was 50 years, and median follow-up was 9 years. Axillary nodes were positive in 31% of the patients who underwent axillary dissection. LRR developed in 6%, LRR followed by systemic recurrence in 5%, and systemic recurrence alone in 13%, 76% had no evidence of recurrence at last follow-up. Age, tumor size, positive lymph nodes, and not receiving chemotherapy or hormonal therapy were independent predictors of LRR. Disease-specific survival among patients with LRR was similar to that among patients with no recurrence. Conclusions Multidisciplinary treatment strategies should be used to accomplish durable locoregional control after BCT. Presented at the 54th Annual Cancer Symposium of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001.     

Long-term complications associated with breast-conservation surgery and radiotherapy

Background Breast-conservation surgery plus radiotherapy has become the standard of care for early-stage breast cancer; we evaluated its long-term complications. Methods We selected patients treated with surgery and radiotherapy between January 1990 and December 1992 (an era in which standard radiation dosages were used) with follow-up for at least 1 year. Patients were prospectively monitored for treatment-related complications. Median follow-up time was 89 months. Results A total of 294 patients met the selection criteria. Grade 2 or higher late complications were identified in 29 patients and included arm edema in 13 patients, breast skin fibrosis in 12, decreased range of motion in 4, pneumonitis in 2, neuropathy in 2, fat necrosis in 1, and rib fracture in 1. Arm edema was more common after lumpectomy plus axillary node dissection than after lumpectomy alone. Arm edema occurred in 18% of patients who underwent surgery plus irradiation of the lymph nodes and 10% who underwent surgery without nodal irradiation. Conclusions Breast-conservation surgery plus radiotherapy was associated with grade 2 or higher complications in only 9.9% of patients. Half of these complications were attributable to axillary dissection, it is hoped that lower complication rates can be achieved with sentinel lymph node biopsy.     

The use of digital photographs for surgical and rehabilitation records. Methods and results

Digital pictures are performed on patients in the pre and postoperative periods, and sometimes during surgery. Seven thousand fourty eight records have been recorded. This method is useful for a multidisciplinary responsibility, particularly for the hand therapist and the splint follow-up. It is also good for patient information, for Workman's compensation doctors and for experts. The pitfall is that one have to manage the records on a strict day by day base.     

Utility of a questionnaire to measure physician-pharmacist collaborative relationships.

OBJECTIVE: To examine the sensitivity and criterion validity of the 14-item Physician/Pharmacist Collaboration Index (PPCI). DESIGN: Substudy of an unblinded, randomized trial of pharmacist interventions with patients with uncontrolled hypertension. SETTING: 6 intervention and 6 control pharmacies in eastern Iowa. PARTICIPANTS: 25 community pharmacists. INTERVENTIONS: Pharmacists completed the PPCI at baseline and at a 3-month follow-up for each patient's physician. MAIN OUTCOME MEASURES: Respondents' perceptions about their relationships with each patient's physicians as measured through scores in three domains, Trustworthiness (TW; score range, 6-42), Role Specification (RS, 5-35), Relationship Initiation (RI, 3-21), and compared using nonparametric tests. RESULTS: Pharmacists' mean scores of their relations with 38 different physicians (54 completed PPCIs) in the intervention group were 33.8 for TW, 23.2 for RS, and 16.4 for RI at baseline. At 3 months, the scores had improved significantly to 35.5, 25.0, and 17.4, respectively. Pharmacists' scores for 43 different physicians (49 completed PPCIs) in the control group did not change significantly between baseline and 3 months (TW, 30.7 at each time point; RS, 20.3 and 19.7, respectively; RI, 14.3 at each time point). CONCLUSION: Improved scores in the intervention group suggest that collaborative relations improved between the physician and pharmacist during the 3-month study, while no such improvement was found in the control group. Since the intervention was designed to promote collaboration between pharmacists and physicians, these results support the PPCI as a tool to measure pharmacist-physician collaboration and could be used by pharmacists to benchmark collaborative relationships. Additional research is needed to corroborate the results of this study.